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  • 1
    ISSN: 1432-1238
    Keywords: Key words Percutaneous dilatational tracheostomy ; Complications ; Results ; Tracheal stenosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To analyze perioperative and postoperative complications and long-term sequelae following percutaneous dilatational tracheostomy (PDT). Design: A prospective clinical study of patients undergoing PDT. Setting: Seven intensive care units at a University hospital Patients: 326 intensive care patients (202 male, 124 female; age: 11–95 years) with indications for tracheostomy. Interventions: Using tracheoscopic guidance, 337 PDTs were performed according to Ciaglias' method. In 106 decannulated patients, tracheal narrowing was assessed by plain tracheal radiography. Results: Two procedure-related deaths were seen (0.6 %). Perioperative and postoperative complications occurred with 9.5 % of the PDTs. One of 106 patients, who were followed-up for at least 6 months, showed a clinically relevant tracheal stenosis. Subclinical tracheal stenosis of at least 10 % of the cross-sectioned area was recognized in 46 of 106 patients (43.4 %). In the univariate analysis, the degree of stenosis was influenced by the age of the patient (p = 0.044), the duration of intubation prior to PDT (p = 0.042) and by the duration of cannulation (p = 0.006). These parameters had no statistical significance in a multiple regression model. Conclusion: When performed by experienced physicians, percutaneous dilatational tracheostomy under fiberoptic guidance is a safe method. The risks of early complications and of clinically relevant tracheal stenoses are low. Subclinical tracheal stenoses are found in about 40 % of patients following PDT.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-2102
    Keywords: Schlüsselwörter MRT ; Kinder ; Tumor ; Abdomen ; Differentialdiagnose ; Key words MRI ; Pediatric ; Tumor ; Abdomen ; Differential diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Purpose: To evaluate the potential of MRI in determining benign and premalignant abdominal tumors in childhood. Methods: MR images of 93 children with 69 malignant and 24 benign abdominal tumors were analyzed retrospectively without and with knowledge of clinical findings. Based on the final diagnosis, MR findings were surveyed with regard to the correct differential diagnosis and to the differentiation between benign and malignant masses. Results: Analysis of MRI alone revealed relatively low sensitivity of 67% for diagnosis of a benign tumor. The main reason was unspecific morphologic criteria leading to the false-negative diagnosis of a malignant tumor. Together with clinical and laboratory findings, sensitivity could be increased to 92%. The main criterion for differentiation of malignant tumors turned to be out the origin of tumor. Benign tumors could be best differentiated by their internal structure. Conclusion: When considering clinical findings in pediatric abdominal tumors, MRI represents a valuable modality for differential diagnosis.
    Notes: Zusammenfassung Zielsetzung: Ziel der Arbeit ist die Bestimmung der Wertigkeit der MRT für die Unterscheidung benigner und prämaligner abdomineller Tumoren im Kindesalter. Methode: Bei 93 Kindern mit 69 malignen und 24 benignen abdominellen Raumforderungen wurden die MRT-Bilder retrospektiv ohne und mit Kenntnis der klinischen Befunde analysiert. Anhand der endgültigen Diagnose wurde die Aussagekraft der MRT in Bezug auf die korrekte Artdiagnose und die Unterscheidung zwischen benignen und malignen Tumoren überprüft. Ergebnisse: Bei der alleinigen MRT-Analyse wurde für die Diagnose „benigner Tumor” eine relativ niedrige Sensitivität von 67% erzielt. Die Hauptursache hierfür waren unspezifische morphologische Unterscheidungskriterien, die zur falsch-negativen Diagnose eines Malignoms führten. Zusammen mit den klinischen Befunden konnte die Sensitivität auf 92% angehoben werden. Als Hauptkriterium für die korrekte Artdiagnose zeigte sich bei den Malignomen die Organzugehörigkeit und bei den benignen Tumoren die Binnenstruktur. Schlußfolgerung: Im Rahmen der integrierten Diagnostik liefert die MRT einen wertvollen Beitrag zur Differentialdiagnostik kindlicher abdomineller Tumoren.
    Type of Medium: Electronic Resource
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